Fatal outcome of disseminated invasive aspergillosis in kidney allograft recipients

Fungal infections in solid organ transplant recipients are of concern due to the related high mortality and morbidity. Aspergillus species are one of the major opportunistic fungal pathogens causing invasive pulmonary infections which rarely involve extrapulmonary organs. The occurrence varies by type of transplantation, with aspergillosis more frequently associated with heart, liver and lung transplantation cases than those involving kidney recipients. Several risk factors have been proposed, with cases occurring early and late after the transplantation. Although pulmonary involvement is the main presentation, invasive extrapulmonary aspergillosis can on rare occasions be observed and is associated with poor prognosis. Herein, we report two cases that presented with extrapulmonary invasive aspergillosis, i.e., one presented with cerebral abscess and the second with soft tissue abscess in the right posterior thigh. While the cerebral abscess was not surgically treated, the soft tissue abscess was surgically drained. When the primary focus was investigated, pulmonary nodulars were found in both cases. Both patients were treated with long-term amphotericin B; however, one patient was lost with functioning graft and the kidney of the second patient failed due to decreased immunosuppression and he died while on maintenance hemodialysis. Invasive extrapulmonary presentation of aspergillosis rarely occurs in kidney transplant recipients and is associated with a high mortality rate.